Exploring the sorting of patients in community health centres across Gauteng Province, South Africa

Abstract

BackgroundPrimary health care worldwide faces large numbers of patients daily. Poor waiting times, low patient satisfaction and staff burnout are some problems facing such facilities. Limited research has been done on sorting patients in non-emergency settings in Africa. This research looked at community health centres (CHCs) in Gauteng Province, South Africa where queues appear to be poorly managed and patients waiting for hours. This study explores the views of clinicians in CHCs across Gauteng on sorting systems in the non-emergency ambulatory setting.MethodsThe qualitative study design used one-to-one, in-depth interviews of purposively selected doctors. Interviews were conducted in English, with open-ended exploratory questions. Interviews were recorded, transcribed, anonymised and checked by interviewees later. Data collection and analysis stopped with information saturation. The co-author supervised and cross-checked the process. A thematic framework was developed by both authors, before final thematic coding of all transcripts was undertaken by the principal author. This analysis was based on the thematic framework approach.ResultsTwelve primary health care (PHC) doctors with experience in patient sorting, from health districts across Gauteng, were interviewed. Two themes were identified, two major themes, namely Systems Implemented and Innovative Suggestions, and Factors Affecting Triage. Systems Implemented included those using vital signs, sorting by specialties, and using the Integrated Management of Childhood Illnesses approach. Systems Implemented also included doctor - nurse triage, first come first serve, eyeball triage and sorting based on main complaint. Innovative Suggestions, such as triage room treatment and investigations, telephone triage, longer clinic hours and a booking system emerged. There were three Factors Affecting Triage: Management Factor, including general management issues, equipment, documentation, infrastructure, protocol, and uniformity; and Staff Factor, including general staffing issues education and teamwork; and Patient Factor.ConclusionDeveloping a functional triage protocol with innovative systems for Gauteng is important. Findings from this study can guide the development of a functional triage system in the primary health care non-emergency outpatient setting of Gauteng’s CHCs. The Emergency Triage, Assessment and Treatment (ETAT) tool, modified for adult and non-clinician use, could help this. However, addressing management, staff and patient factors must be integral.

Waiting times, patient flow, and occupancy density in South African primary health care clinics: implications for infection prevention and control

“…Triage (broadly defined as the process of prioritising patients for care based on their needs) [54] has also been shown to reduce waiting times in a hospital in South Africa, though it was less effective when used in two PHC clinics. [55,56] Effective triage can be challenging and resource-intensive to sustain, [57] and sub-optimal implementation of symptom-based triage for TB IPC has been documented by several studies. [58][59][60][61] Active queue management has also been tested: a qualitative study around the use of a 'Fast Queue' in clinics in KZN found that the use of multiple, managed queues was generally well-received by attendees, particularly if accompanied by smooth (i.e., unidirectional) flow and effective communication with HCWs, though there were still those who experienced long waiting times.…”

Using mystery shoppers to determine practices pertaining to antibiotic dispensing without a prescription among community pharmacies in South Africa—a pilot survey

“… 7 , 45 However, there can be medicine shortages in the public healthcare system in South Africa, and in many PHCs patients have to wait a long time to see either a nurse or physician as PHC facilities are under-resourced. 48 , 49 This could be an issue for the economically disadvantaged if there are long waiting times resulting in these patients potentially seeking treatment elsewhere to ensure daily wages. 47 This includes community pharmacists, who are typically open longer hours and with limited waiting times.…”

“… 47 This includes community pharmacists, who are typically open longer hours and with limited waiting times. 48 However, this will be subject to 100% co-payment unless the patient has private insurance.…”

Determining the Need for After-Hours Diagnostic Radiological Reporting in Emergency Departments at Public Hospitals in South Africa: Perceptions of Emergency Physicians in KwaZulu-Natal

“…Clinics in South Africa mainly offer primary health care services to the public during office hours, but they are often closed during after hours, overcrowded, short-staffed, and lack essential resources such as radiology services [3]. Public service emergency departments are therefore overcrowded, after hours, by patients who would otherwise have been treated at a primary health care facility [6,7], where patients visiting these departments often present with a myriad of conditions associated with chronic or acute illnesses or as a result of trauma [8]. This is causing a greater burden on public emergency departments [9,10], together with extended waiting times, poor patient care, and increased patient mortality [11][12][13].…”